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The 3rd Asia-Pacific CBR Congress

Paper Submission from Fu Hong Society (Hong Kong)
Topic: Non-handicapping Environment

Title of presentation: From deinstitutionalization to community-based rehabilitation services – a pathway to personal recovery

Frankie Tsui1, Apple Sung2, Joseph Kwok3

Mental Health Services in Hong Kong

Mental health service in Hong Kong in the form of a detention model could be traced back to the early 19th century. Its modern development to a community-based rehabilitation model, has accelerated only from the early 1990s. Currently, mental health services are mainly provided by Government Social Welfare Department (SWD), Hospital Authority (HA) and non-governmental organizations (NGOs) and the latter two sectors are heavily subvented by Government. SWD and NGOs focus on social and rehabilitation services in the community while HA is the statutory body providing comprehensive in-patients and out-patients, as well as community outreach, services. No single organization can render the full range of services because of the complexity and heterogeneous needs of persons in recovery and their caregivers. Complementarily coordination is required to provide a seamless service to best meet their needs.

Development of Community-based Residential Services

Similar to the experiences of western and some developing countries, the negative impacts of institutionalization, the emerging psychiatric drugs and the positive community living experience of persons in psychiatric remission are the main forces leading to the development of community-based mental health services.

In Hong Kong, policies supporting de-institutionalization and community care have developed since 1980s. Over the past decades, in-patient occupancy and average length of stay in hospital have decreased gradually. As a result of moving from institutionalization care to community care, various community-based residential services have been set up since then. Community residential services have become a very important transition in the process of “deinstitutionalization”.

The major types of residential services in Hong Kong include Long Stay Care Homes (LSCH), Halfway Houses (HWH), and Supported Hostels for persons with mental health recovery ill persons who are homeless or with little family support. These residential care services aim to provide a supportive environment with appropriate support to assist them to live independently in the community. Community support services have been further strengthened when SWD launched Integrated Community Centre for Mental Wellness (ICCMW) across the territory in 2010 to replace small size and loosely connected community mental health support services.

The population of Hong Kong was 7.24 million in mid-2014 and is one of the most densely populated cities in the world. The stressful urban living situation diminishes the level of tolerance toward persons in recovery. A single episode of severe incident will trigger public concerns and stir up public fear toward mental illness. Social stigmas is still not uncommon in a highly commercial and civilized place like Hong Kong. For the purpose of achieving social stability, halfway houses, though comparatively in smaller scale and size, are expected to be functioned as mini-institutions with guided supervision.

Experience of Fu Hong Society’s Halfway House Service on Personal Recovery

Fu Hong Society has adopted “Recovery-oriented” practice in delivering halfway house services. Anthony (1993)4 define “Recovery” as "a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness."

Halfway House, as a community-based residential service, has all along been serving as a bridge moving towards inclusive community living for persons in mental health recovery. Fu Hong Society operates three purpose-built Halfway Houses located in Aberdeen on Hong Kong Island, namely Yuet Kwan Home, Yuet Chi Home and Yuet Hang Home with a total 126 residential placements and subvented by Government.

In traditional institutional setting, collective arrangements and control measures are enforced to ensure efficient operation. Policies and regulations are established mainly based on administrative consideration. Interaction between staff and inmates are top-down and one-way. In some situations, individual voices and needs are ignored by rigidity of routines. “Chronic” inmates in hospital are accustomed to institutionalized life after a long staying period. They become submissive and passive with low motivation to face the complexities of living in community.

The “Recovery-oriented” practice adopted by Fu Hong Society has the following key features:

1. Staff are alerted and equipped to be aware of the negative impacts of institutionalized living, and provide flexibility, choices and opportunities to service users of halfway houses

Living in group setting creates inevitable tensions and stresses. A home-like environment is enlightening and conducive to stress removal. The sense of comfort, security, companionship and belonging can facilitate meaningful interaction between people living and working there. The set-up of a “Good People, Good Deeds” platform was to promote positive energy. Users and staff are encouraged to identify good things and show appreciation in words. Just a kind word and loving drawing not only can make a positive and far-reaching change on the home atmosphere and culture, but also to counteract the negative impacts of institutionalization.

Staff development program is critical and significant to promote changes. Workshops training on “Recovery practice and Coaching” are organized to equip staff with adequate knowledge and skills with a view to extending and expanding staff’s mentality, self-reflection on own values and attitude from focusing on personal weaknesses and functional deficits to strengths, interests and capabilities. Staff workers have become more humanistic, flexible and dynamic in working along with service users.

In service delivery, choice is an important guiding concept. Halfway house provides a wide range of options in activities and programs according to service users’ needs and interests. They are free to choose and their wills are being respected. No coercion but encouragement is given to enhance user participation. The “Opinion Wall” and “User Sharing Session” are set up for ongoing collection of views and comments on daily management. Besides, “User Satisfactory Survey” is conducted to get feedback from service users annually.

2. Persons with psychosocial problems are supported with maximum opportunities to enhance full participation in their recovery journey

Partnership is another principle adopted in halfway house service. Partnership in relationship addresses respect, choice, participation and balanced power. Staff workers act as a collateral for the recovery journey, while persons in recovery are “expert in experience”. Their personal accounts of lived experience is appreciated as asset. Service users are encouraged to participate openly and actively in formulating the person-driven recovery care plan in the “Individual Progress Meeting” conducted regularly with an aim to equip for independent living and minimize the passivity throughout the empowerment process.

Compassionate Rehousing (CR) is a form of housing assistance which aims to support individuals and families having social or medical needs processed by Housing Department (HD) through the recommendation of SWD. Service users with good progress of recovery and imminent housing need will then be allocated a singleton public rental housing unit in a preferred district for community integration. As a continuation of service, the ICCMW will provide the one-stop and district-based community support services for discharged users from halfway house living in the community.

3. Mobilizing community social network support and resources to facilitate full integration into the community

Persons in recovery should be supported with maximum opportunities to enhance full participation in their recovery journey. For the purposes of building up a healthy life style and widening their support network in community, a diverse range of social inclusion activities are organized, such as, running / hiking / soccer competition, music performance, pet activities, volunteer services, social activities and vocational training while they are receiving halfway house services.

More importantly, the building up of peer relationship plays an important part of mutual emotional and social support among persons in recovery. Through peer support programs initiated by themselves, they develop personal hobbies and learn how to utilize community resources such as library, sports facilities and museum etc. With enhanced confidence in living independently upon discharge from halfway house, they can achieve their personal goals with full participation and sufficient social support network in the community.

Conclusion

The stigma of mental illness can be distressing and dehumanizing to persons in recovery and their families. Fu Hong Society have endeavored to empower service users by optimizing opportunities, upholding individualized choice, encouraging full participation and mobilizing community network and resources with a view to strengthening their self-esteem and capabilities in the recovery journey. Through personal interaction and community involvement, a boarder and deeper understanding on persons in recovery can be established among the general public. This process can help eliminate prejudice on mental illness and create a recovery-enhancing environment in future.

Reference

Anthony W.A. (1993). Recovery from Mental Illness: The Guiding Vision of the Mental Health Service System in the 1990s. Psychosocial Rehabilitation Journal, 1993, 16(4), 11–23.

Kwok J. (2006). “Deinstitutionalization”, in Tony Fitzpatrick, Editor in Chief, International Encyclopedia of Social Policy, Volume 1. Routledge, pp. 267-268.

Wong F. K. D. & Yu W. M. R. (2006). Clinical case management for people with mental illness: A bio-psychosocial vulnerability-stress model (An expanded Chinese Version). Hong Kong: Chinese University Press.

Brief CV of the Writers

Frankie TSUI

Photograph

1) Frankie TSUI, Registered Social Worker (RSW), is the current Assistant Executive Director of Fu Hong Society, Hong Kong. She has been working in rehabilitation services for persons with disabilities for almost 25 years with the expertise of social service management and mental health services. In addition, she has endeavored to advocate the UN Convention on the Rights of Persons with Disabilities in the past years.

2) Apple SUNG, Registered Social Worker (RSW), is the current Service Unit Manager of Yuet Hang Home of Fu Hong Society. She has been working in mental health service for 16 years with rich experience in residential service for person in recovery.

3) Joseph KWOK, Registered Social Worker (RSW), Ph.D., Bronze Bauhinia Star (BBS, 2005), Justice of Peace (JP, 1997), is a Council member and Hon. Secretary of Fu Hong Society. He is the current Global Chair of the Social Commission of Rehabilitation International, Vice Chair of Asian Pacific Disability Forum. He was a member of the Publication Organizing Committee, and co-editor of the Chinese translation of Community-based rehabilitation: CBR guidelines. WHO, 2010. In Hong Kong he had served as Chairman of HKSAR Government Rehabilitation Advisory Committee, and member of Equal Opportunity Commission. He was a recipient of the Kazuo Itoga Memorial Award by the Shiga Prefecture, Government of Japan in 2006 in recognition of his contribution to disability work in both Hong Kong and the Region.


1 TSUI Kwan-yin, Frankie, Registered Social Worker (RSW), is the Assistant Executive Director of Fu Hong Society, Hong Kong.

2 Sung Hor-mui, Apple, Registered Social Worker (RSW), is the Service Unit Manager of Yuet Hang Home of Fu Hong Society, Hong Kong.

3 Joseph Kwok, Registered Social Worker (RSW), Ph.D., Bronze Bauhinia Star (BBS, 2005), Justice of Peace (JP, 1997), is a Council member and Hon. Secretary of Fu Hong Society.

4 Anthony W.A. (1993). Recovery from Mental Illness: The Guiding Vision of the Mental Health Service System in the 1990s. Psychosocial Rehabilitation Journal, 1993, 16(4), 11-23.


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